You're now familiar with the key principles and elements of participatory approaches, including why they are important. You've also discussed some examples in the case studies and hopefully from your own experience. Now, I want to move on some specific aspects of the use in public health practice, provide you with some more examples and point you to some tools that you can use in your own work. Public health practice covers a number of different domains and services, and participatory approaches can be applied to many of these. I'm going to refer to one public health model, which identifies four core domains: health improvement, health protection, health service delivery, and health Intelligence. Underpinning all of these is research and systems management. I can't describe participatory approaches for all of these, but will provide some brief examples for measuring and monitoring population health, disease surveillance, health improvement projects, and service quality improvement. You can then refer to the resources for more ideas and case studies, including a table of appropriate methods. Start with monitoring health, measuring monitoring population health, and identifying key health issues. Standard public health approaches include the collection and analysis of routine health data, much of which comes from reporting in health care settings, and statutory functions such as death certification or disease notification. As you probably know, these systems are only as good as the data that are collected are a variable quality and coverage, and only some information and types of data are included. A number of more inclusive and innovative methods have been developed, including: participatory needs assessments and surveillance, community mapping, and the use of tools such as photovoice. The photovoice method involves providing local community members with cameras, to document aspects of their lives, including health issues, and to draw these together as a powerful way of influencing policy and priorities. As part of a project on the social determinants of health, residents in a Glasgow housing estate created scrapbooks with photos and words showing how the local environment affected their health. The pictures, include the examples of neglect, rubbish, highlighted the lack of green space and taken together, it showed how these environmental factors affected both mental and physical health. Details of this at other projects can be found in a video in the resource section, and there's an interview with a public health researcher on using photovoice and other innovative methods. Other approaches include problem trees, community mapping, and health monitoring. Surveillance, there are many innovative and participatory approaches to surveillance which use the power of including large numbers of volunteers to share their health status in what someone called citizen science. One example is flusurvey, this is an online tool to monitor flu-like illness in the community, it's been operating in the UK since 2009. People voluntarily sign up to the site and complete some basic information about themselves, their household and then during the flu season, they report any symptoms and also say whether they've been vaccinated? How many people they're in contact with? Their travel habits and other key data. Similar systems exist in many countries using web-based or app-based approaches, and these provide a relatively low cost surveillance and have been found to be very timely in detecting changes in population health status. Similar approaches are being applied to other challenges such as detecting emerging threats. By actively engaging the community in providing data, these methods can also be used to communicate health messages and to educate the public as people regularly visit the site, and can be reached with information, or be invited to take part in research. Health improving programs. Another example is around health improvement programs and there are many different participatory approaches. These may be focused around a particular intervention such as vaccination, and work is done with members of the community, community organizations, and key local figures, to identify ways to get this implemented most effectively. The use of peer educators or health champions has been very effective in improving access of some communities to existing services. It is important that these peers act to facilitate two-way communication, they may be employed to advocate a particular intervention to a community. For example, the use of contraception. But they should also be able to advocate for those community members and ask the health services to address other key issues. There are many other approaches to community participation, which often start with the mapping of health problems with community groups or local surveys, and use qualitative research methods to better understand this, and then engage local people in identifying priorities for action. So these are just a few examples of how participatory approaches can be used in different functions of public health, and you will find more in the readings and the interviews. For now, think about a particular public health challenge that you are facing or is of interest to you, and think how you might use one or more of these approaches.
